Hyponatremia is a risk factor of hepatic encephalopathy in patients with cirrhosis: A prospective study with time-dependent analysis
Por:
Guevara M., Baccaro M.E., Torre A., Gómez-Ansón B., Ríos J., Torres F., Rami L., Monté-Rubio G.C., Martín-Llahí M., Arroyo V., Ginès P.
Publicada:
1 ene 2009
Categoría:
Gastroenterology
Resumen:
OBJECTIVES:The aim of this study was to investigate whether hyponatremia is a risk factor of overt hepatic encephalopathy (HE) in cirrhosis.METHODS:A total of 61 patients with cirrhosis were evaluated prospectively for 1 year and all episodes of overt HE were recorded. Predictive factors of HE were analyzed using a conditional model (Prentice, Williams, and Peterson) for recurrent events to assess the relationship between HE and time-dependent covariates. The effects of hyponatremia on the brain concentration of organic osmolytes were analyzed in 25 patients using 1H-magnetic resonance spectroscopy.RESULTS:Twenty- eight of the 61 patients developed 57 episodes of overt HE during follow-up. Among a number of clinical and laboratory variables analyzed, the only independent predictive factors of overt HE were hyponatremia (serum sodium <130mEql), history of overt HE, serum bilirubin, and serum creatinine. Hyponatremia was associated with low brain concentration of organic osmolytes, particularly myo-inositol (MI). Furthermore, patients with low brain MI levels had a higher probability of development of overt HE compared with that of patients with high brain MI levels.CONCLUSIONS:In patients with cirrhosis, the existence of hyponatremia is a major risk factor of the development of overt HE. Treatment of hyponatremia may be a novel therapeutic approach to preventing HE in cirrhosis. © 2009 by the American College of Gastroenterology.
Filiaciones:
Guevara M.:
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalunya, Spain
Liver Unit, Hospital Clínic, Villarroel, 170, 08036, Barcelona, Spain
Baccaro M.E.:
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalunya, Spain
Torre A.:
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
Gómez-Ansón B.:
Radiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
Ríos J.:
Statistical Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
Torres F.:
Statistical Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
Rami L.:
Department of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain
Monté-Rubio G.C.:
Radiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
Martín-Llahí M.:
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalunya, Spain
Arroyo V.:
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalunya, Spain
Ginès P.:
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalunya, Spain
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